1. The Post-Surgical Prosthetic Rehabilitation of a Patient with Squamous Cell Carcinoma Faghrie Meer BTech Student in Dental Technology

2. Contents Patient history Background and condition Clinical treatment options Technical treatment options Most desirable technical treatment options

3. Contents… continued Chosen technical treatment option Laboratory procedures Final placement References

4. Patient History 68 years old Female Fair-skinned Sun exposure Fully edentulous

5. Patient History… continued Main Complaint: Inability to wear lower denture Dental Faculty Squamous cell carcinoma in 3rd quadrant Chin and alveolar ridge

6. Patient History… continued April 2002-Fibula graft; Skin graft. May 2002-Both plates broke. June 2002-Both plates removed and re-evaluated.

7. Patient History… continued July 2002-Thinning of skin flap. Sept. 2002-2 implants inserted. Oct. 2002-Liposuction in chin area.

8. Background and Condition Malignant epithelial tumour 1 Overgrowth of tissue cells Destruction of living cells

9. Background and Condition… continued Common and fatal if unrecognized 2 Favourable prognosis Curable

10. Clinical Treatment Options Two options: a) Radiation or b) Surgical removal

11. Radiation Highly contra-indicated: 1 1) Not precise 2) Oral sensitivity 3) Destruction of oral structures:

12. Radiation… continued a) Dry oral cavity b) Poor tissue healing c) Difficulty in mastication d) Difficulty in digestion

13. Surgical Removal Desired treatment option Cancer and healthy tissue removed 2 Growth initiation

14. Surgical Removal… continued Regular check-ups essential Unnoticed growth is fatal

15. Technical Treatment Options Bar and clips attachment system

16. Technical Treatment Options… continued Magnetic attachment system

17. Technical Treatment Options… continued Ball attachment system

18. Most Desirable Technical Treatment Option Bar and Clips Attachment System Greatest retentive ability 3, 5, 6 Strong and rigid attachment Anti-corrosive clips Good load distribution

19. Chosen Technical Treatment Option Ball Attachment System Most cost-effective system 3, 4, 6 Accurate and repeatable denture placement Satisfactory retention and stability

20. Ball Attachment System… continued Maligned abutments not critical Little space required Better hygiene Ease of fabrication

21. Magnquateetic Attachment System Accurate clinical techniques Inadequate shear loads Discolouration Allergic reactions Loses retentive abilities

22. Laboratory Procedures 1° impressions 2° impressions Surgical stent Tissue integration

23. Laboratory Procedures… continued Temporary mandibular denture Phase 2 treatment plan 2° impressions Permanent denture

24. Laboratory Procedures… continued Female counterpart Implant too far facially Attachment selection difficult

25. Laboratory Procedures… continued Molloplast-B Flasked and processed

26. References 1) J. C. E. Underwood. Skin. General and Systematic Pathology. 2nd ed. London: Churchill Livingstone. 1996: 764-765. 2) R. N. M. MacSween & K. Whaley. Alimentary tract. Muir’s Textbook of Pathology. 13th ed. London: Arnold. 1995: 680-681.

27. References… continued 3) H. W. Preiskel. Stud attachments and magnets, Bar attachments. Overdentures Made Easy: A Guide to Implant and Root Supported Prostheses. Berlin: Quintessence Publishing Co Ltd. 1996: 81-89, 101- 108, 119-133.

28. References… continued 4) Guerra et al. Alternative retention for an implant-retained prosthesis. Journal Of Oral Implantology. 2002; 28(3): 117-120. 5) K. Bergstom. Anaplastological technique for facial defects. Osseointegration Anchorage Of Craniofacial Prostheses. 1998: 101-106.

29. References… continued 6) E. J. Penn & R. P. Renner. Overdentures-an overview for the general practitioner. Quintessence Of Dental Technology. 1991; 14: 131-141.

30. Acknowledgements Dr Van Zyl Prof. Morkel Mrs Nortje Mrs Wright Mr Steyn Mr Mazema Mr Lategan